the beast in the bathhouse
by Andrew Jacobs
Article appeared in The New York Times (January 12, 2004)
Bob looked haggard but was feeling fabulous. Chewing gum at a manic clip, circling the labyrinthine halls of the West Side Club on a recent Sunday afternoon, he had been awake since Friday, thanks to a glassine pouch of crystalline powder he had tucked beneath the mattress of a room he rented in this Chelsea bathhouse.
The powder, known as methamphetamine, or crystal meth, had helped Bob conquer a half-dozen sex partners during a 35-hour binge. Like many of the men cruising the two-level club lined with closet-size cubicles, Bob, a 37-year-old advertising copywriter, was "tweaking," high on a wildly addictive stimulant that has been sweeping through Manhattan's gay ghettos.
"The stuff is a wonder," he said, taking a pause from his prowling, his scrawny frame wrapped in a white towel. Asked about condoms and the niceties of safe sex, Bob shrugged. "Whatever," he said, turning away.
At the club, there were plenty of condoms for the taking, courtesy of the management, but in conversations with a dozen patrons who acknowledged using crystal, only two men said they were following the rules of engagement in the age of AIDS. "Some guys just throw you out of the room if you pull one out," said one of the men, James, who, like everyone else, would not give his full name. "To them, rubbers are a killjoy."
Health officials say a sharp increase in the number of syphilis cases in the city indicates an increase in unsafe sex, which they fear may lead to a resurgence in H.I.V. transmission.
For now, researchers say, crystal meth use in the city is largely confined to gay white men in Manhattan, although they fear its eventual spread to the wider gay population and beyond.
There are no numbers, however, to show what health care workers say is the growing role that crystal meth is playing in transmitting H.I.V. Although the evidence is anecdotal, health officials say that crystal, which erases inhibitions and spurs sex marathons with multiple partners, is helping to spread the virus.
According to the city's largest private clinic for lesbians and gay men, Callen-Lorde Community Health Center, two-thirds of those testing positive for H.I.V. since June acknowledged that crystal meth was a factor in their infection.
Dr. Howard Grossman, one of the city's best-known AIDS specialists, said more than half the men who test positive in his private practice blamed methamphetamine. "This drug is destroying our community," he said. "It just seems to be getting worse and worse, and no one is doing anything about it."
Although the city Department of Health does not track crystal meth use among the newly infected, the city's poison control center received four dozen reports of crystal meth overdoses in 2002 and 2003.In the previous two years, there were none, said the city's health commissioner, Thomas R. Frieden. In another survey, the agency found that H.I.V.-positive men were twice as likely as uninfected men to use methamphetamine; those who use the drug were also less likely than other men to wear condoms during anal intercourse. "We're seeing a general increase in risky sexual behavior, and we're concerned," Dr. Frieden said.
Sometimes called crank, ice or tina, crystal meth is not new. For years, it has been cutting a destructive path through working-class communities in the Midwest and among gay men in San Francisco and Los Angeles. The drug found a toehold in New York dance clubs in the late 1990's and quickly spread among gay men who troll the Web for sex. Most start off snorting crystal, progress to smoking and later inject the drug when tolerance mounts. Even a small amount, about a quarter gram for $60, can propel a user through a weekend devoid of sleep, food and self-preservation.
During his eight-year addiction, Devin, a 38-year-old magazine writer, ended up in the emergency room six times from the effects of dehydration or a perilously rapid heartbeat. He lost five jobs, and four teeth began to rot from neglect and speed-induced jaw grinding. "Food, sleep and H.I.V. medication go out the window," he said. "Crystal takes over your life entirely. You don't really care about anything except the next high."
One figure might reveal how entrenched crystal meth has become in New York: Nearly two dozen 12-step meetings are held each week around the city for those trying to shake the drug. In 2002, there were four Crystal Meth Anonymous meetings each week. In 1999, there were none.
"Just a few years ago, we were worrying about the arrival of crystal meth," said Perry N. Halkitis, a psychologist at New York University. "Well, it's finally here."
He and others say that if past drug trends are any indication, crystal will migrate beyond the province of gay men, just as it has in the heartland, where the drug has become symptomatic of rural decline. "It's just a matter of time," Dr. Halkitis said.
It didn't take long for Jim, a 34-year-old freelance editor, to become acquainted with crystal and AIDS. He believes he was infected during his first encounter with the drug in 1999, at the home of someone he met over the Internet. "The guy offered me some. I didn't really know much about crystal and I did it. I got so high, I was essentially having nonconsensual sex."
A veteran AIDS activist, Jim knows he should have known better. "Once I was diagnosed, I was so embarrassed and ashamed, it fueled my addiction," he said. "I became the beast that eats its own tail."
For four years, Jim handed his life over to meth. What began as a weekend habit quickly became a daily dependence. Old friends were pushed away, jobs went by the wayside, and his credit card debt reached $40,000. He contracted syphilis twice. And coming down was excruciating. "When you're crashing, all you want to do is get high again," he said. "It's single-minded and ugly."
As addiction deepens, crystal meth wreaks havoc on the brain. In advanced cases of addiction, users can become psychotic with effects that mimic schizophrenia, says Dr. Antonio Urbina, a researcher at St. Vincent Catholic Medical Center who studies the drug's impact on neurological function. He says the drug can also compromise immune function and interfere with AIDS medications. "If you're H.I.V. positive, crystal is a disaster," Dr. Urbina said.
Despite what experts describe as an emerging crisis, neither public health officials nor private gay organizations in New York have done much to quell crystal meth's spread. San Francisco, by contrast, will spend $425,000 for education and treatment.
Dismayed by the lack of public attention to the problem, one recovering addict has decided to demonize the drug on his own. Peter Staley, a driving force behind the AIDS activist group Act Up, has spent $6,000 of his own money to place provocative ads on phone booths along Eighth Avenue in Chelsea. He said it took two months to persuade Verizon to accept the posters, which shout "Huge Sale, Buy Crystal, Get HIV Free!"
The ads, which began appearing last Wednesday, will remain up until early February. "My goal is to get the drug the reputation it deserves," said Mr. Staley, who has been sober for 13 months. "My fear is that young gay men think it's the latest party drug. I want crystal to get the stigma that heroin has. It is not glamorous, it is not alluring."
Like many other crystal neophytes, Mr. Staley began using the drug to keep him going at all-night dance clubs. "I've tried every drug in the book and never got addicted, but this one grabbed me by the throat the first time I did it," said Mr. Staley, 43, who has been H.I.V. positive since 1985. "I'm a control freak. I mean, I couldn't get addicted to cigarettes, but I couldn't give crystal up."
Drug experts say there is no methadone, no silver bullet, to treat methamphetamine addicts. For this reason, substance abuse counselors are preaching to "just say no" to crystal. It is a message that many gay men do not want to hear.
"When it comes to crystal, there is no moderation," said Dawn Harbatkin, the medical director at Callen-Lorde, which is conducting a pilot study on ways to treat crystal meth addiction. "I don't have any great treatment options right now. This drug really terrifies me, and I think what we're seeing is the tip of the iceberg."
© 2012 San Francisco AIDS Foundation. All rights reserved.